NPI | 1396122065 |
---|---|
Former Name | DANIELLE MARIE RICHARDSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: MN 63250) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2015-05-01 |
Last Update Date | 2018-07-03 |